White House medical reports are historically unreliable — what’s the cure?

American presidents have long released rosy medical assessments of their physical and mental health, but those flattering reports often are undercut by public skepticism and fresh revelations of problems.

The medical reports are supposed to reassure the public and warn America’s enemies that a strong, fit commander in chief is in charge. However, the released records are often scarce on details, keeping basic facts about presidents’ health shrouded in mystery.

Although the reports have never been known for transparency, recent disclosures about President Trump and his predecessor, President Biden, have reenergized calls for the White House to be more open about medical reports. The two oldest men to ever serve as president both released glowing medical reports, eroding public trust in the process.

Some are calling for reforms, while others wonder why the White House engages in this Kabuki theater in the first place.

“I would put absolutely no faith in these reports whatsoever,” said Jacob Appel, a psychiatry professor at the Icahn School of Medicine at Mount Sinai and a presidential health historian.

“Since the nation’s founding, doctors have deceived the public regularly about the medical condition of the president. Integrity or honesty, in theory, would be the exception rather than the rule,” he said.

Mr. Trump, 79, revealed in October that he underwent an MRI scan during a rare second physical of the year at Walter Reed National Military Medical Center. Neither Mr. Trump nor the White House immediately said which part of the body was examined or what doctors were looking for, causing rampant speculation.

An Oct. 13 letter written by Mr. Trump’s doctor did not mention specifically an MRI scan. It said the president underwent “advanced imaging tests” and “laboratory testing.” The letter declared Mr. Trump was in “excellent overall health.”

After nearly two months of demands for transparency, the White House released a memo from Mr. Trump’s doctor, Sean Barbabella, saying the president had an MRI of his heart and abdomen in October as part of a preventive screening for men his age. The statement said the advanced imaging procedure is “standard for an executive physical” in Mr. Trump’s age group.

Dr. Barbabella said the cardiovascular and abdominal imaging was “perfectly normal.”

“The purpose of this imaging is preventative: to identify issues early, confirm overall health and ensure he maintains long-term vitality and function,” the doctor wrote.

In July, Mr. Trump received a diagnosis of chronic venous insufficiency. It’s a condition in which the valves inside certain veins don’t function correctly, allowing blood to accumulate. He also has had bruising on his right hand that he has sought to cover up with makeup. Officials have said the bruising is because he shakes so many hands.

For weeks after Mr. Trump’s impromptu disclosure to reporters about the MRI, the White House offered few details on why doctors thought the procedure was necessary. White House press secretary Karoline Leavitt said the MRI, which stands for magnetic resonance imaging, was a “routine” part of his physical exam.

“President Trump received advanced imaging as part of his routine physical exam. The results were reviewed by the attending radiologists and consultants, and they all agreed President Trump remains in exceptional physical health,” Ms. Leavitt said.

For nearly all Americans, an MRI is not part of a routine annual physical exam. It is also somewhat unusual for a president to undergo a second physical exam in a year, especially since Mr. Trump underwent a physical exam in April, just six months earlier.

Mr. Biden, 82, revealed this year that he has an aggressive form of prostate cancer. At the time of disclosure, Mr. Biden said the cancer had spread from his prostate to his bones, suggesting he had had the disease for some time.

The diagnosis has heightened suspicions that Mr. Biden, his doctors and family were covering up important medical information. However, some experts have conceded it’s possible the cancer emerged only recently. A spokesperson for Mr. Biden said the former president hadn’t received a prostate cancer screening since 2014.

Mr. Biden’s cognitive and physical decline was laid bare during his presidency with embarrassing memory lapses, moments of confusion and other mental misfires that culminated with his disastrous debate against Mr. Trump last year.

Administrations have legal requirements to be transparent about a president’s health, and doctors are bound by legal and ethical confidentiality. That means the results are released at the sole discretion of the president.

For most of the country’s history, presidents have been reticent or have outright lied about their health.

President Cleveland had a cancerous tumor removed from his mouth aboard a yacht in hopes that word would not get out. When a reporter disclosed the surgery, his administration insisted it was fake news and smeared the reporter.

In 1979, President Carter was trying to keep his bout with hemorrhoids a secret, but his friend, Egyptian President Anwar Sadat, broke the news by asking the people of Egypt to pray for the U.S. president.

President Wilson suffered a stroke in 1919 that left him confined to his bed for most of his term, with his wife acting as president, but the extent of his incapacity was kept from the public. In an era before television, President Franklin D. Roosevelt hid his use of a wheelchair because of polio and kept his congenital heart condition under wraps.

Things began to change under President Eisenhower, who suffered multiple heart attacks and sought to address concerns about his fitness for office by appearing in public from his hospital bed and, later, a wheelchair, during his recovery.

President Kennedy hid the fact that he suffered from Addison’s disease, an insufficiency in the adrenal glands, which help regulate the body’s reaction to stress. He also was treated with opiates for chronic back pain.

Some have proposed overhauling how a president’s medical information is collected and released. An idea that floated around Congress during the Biden administration was having a president examined by a panel of independent physicians. The panel would then discuss its findings at a public press conference. The panel members would be required to disclose any areas of disagreement they have about the president’s health.

“If it were a doctor not chosen by the president, it could give us some reassurance that what we are getting is accurate. I would lean towards university hospitals in terms of my sense of trust and integrity,” said Thomas Balcerski, a presidential historian at Eastern Connecticut State University, “These [White House physicians] are handpicked individuals that have the president’s best interest at heart, whose messaging veers far too political in terms of how it’s being delivered. It’s not objective at all.”

It wasn’t until President Nixon that presidents began undergoing annual physicals and releasing the results to the public.

“Historically, presidents tend to hide the worst of their health diagnoses. That has been borne out, episode after episode, case after case, administration after administration,” Mr. Balcerski said.

Mr. Balcerski questions whether presidents are getting the best possible care. He cited studies that show medical tests for high-level celebrities, politicians and other luminaries tend to miss issues because they are catering to the patient shelling out big bucks rather than the typical standard of care.

“If the president is examined by a sycophantic medical team who would not want to upset him in any way, then, potentially, he’s not getting the best care he deserves,” he said.

Dr. Appel said the country and the president might be better off with the lack of transparency. He said more detailed medical reports might force a president to be less honest with his doctor out of fear that something negative might be disclosed to the public, meaning he wouldn’t get the appropriate care.

In addition, anything disclosed to the American public also would be disclosed to the governments of adversaries such as Russia and China.

“I’m not sure we want these things to be reliable,” Dr. Appel said. “If we decided we really wanted to do something, even then, we are still constrained by the political process. Everybody wants the opposing candidate to look sick and theirs better. It would devolve into a political game, and nobody would take the data seriously, even if it were accurate.”